A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to have a look at how efficient at weight reduction it really is and simply how dangerous the unwanted side effects really are. We additionally cowl implications of the remedy scarcity and concerns for these with a historical past of an consuming dysfunction or disordered consuming. 
Set off warning: discussions of weight reduction numbers, consuming dysfunction behaviors
Ozempic and different weight reduction drugs like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching matter proper now.
Celebrities are publicly attributing their weight reduction to those drugs (Oprah being the most recent one as I’m scripting this). Medical doctors are prescribing them left and proper for weight reduction (and every other ailment you may deliver to the physician that they assume is correlated to your weight). Sufferers with diabetes (for whom these drugs had been initially developed) can’t entry these meds as a result of there are shortages throughout the nation and their well being is struggling consequently.
From information headlines to TV ads to water cooler speak, Ozempic is in all places. As a non-diet, weight-inclusive dietitian, I wish to guarantee that I’m empowering my shoppers and my neighborhood with all of the evidence-based info we now have (and spotlight what we don’t have) as a way to make an knowledgeable resolution on whether or not or to not take these drugs. It’s not my function to steer you (as a result of I imagine in your company and physique autonomy) however it’s my function to teach and inform, which I hope to do right here.
I’d by no means, ever disgrace or decide somebody who decides to take these drugs. It will make sense for those who select to take them or are enthusiastic about taking them given the anti-fat tradition we dwell in and the stress from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve realized about these drugs on this submit and am highlighting what the analysis exhibits us on weight reduction (how a lot weight you’re really prone to lose – trace: it’s not as a lot as you may assume), what the recognized unwanted side effects are, and why you have to be cautious about the place you’re accessing these meds from.
What’s GLP-1?
These weight reduction drugs fall into a category of medicines known as GLP-1 agonists. GLP-1 is glucagon-like peptide, also referred to as an incretin. Incretins are secreted within the small gut and assist to extend insulin, lower glucagon and decelerate gastric emptying (i.e. digestion), all of which assist to handle blood sugar. With incretin, glucose can slowly enter the bloodstream as a substitute of being flooded with it.
It additionally stimulates satiety and fullness and helps you keep full longer, which is why the remedy is now getting used to manage urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic identify for the energetic ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the therapy of diabetes, and in 2021, Wegovy grew to become FDA-approved for the therapy of weight reduction. Each are primarily the identical remedy solely Wegovy has increased doses of semaglutide.
As soon as Wegovy grew to become FDA-approved for weight reduction, it shortly went into scarcity after which medical doctors started prescribing Ozempic off-label (that means prescribing it for one thing aside from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages shortly adopted go well with.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes therapy aren’t attending to the individuals who want them essentially the most and might have severe well being ramifications for these with diabetes.
Semaglutide remains to be in scarcity as of scripting this weblog submit in December 2023.
How do GLP-1 agonists assist these with diabetes?
In of us with diabetes, incretin’s results are decreased (by about 30%), which results in increased blood sugars and poorer blood sugar management. GLP-1 agonists assist management blood sugar and decrease A1c ranges, which measure your common blood sugar ranges over the past three months. Research present these drugs might help decrease A1c ranges by 1 – 2.4 share factors and might cut back the danger of cardiac occasions, no matter weight modifications.
5 issues it is best to find out about Ozempic and Wegovy (and different GLP-1 agonists)
1. You could or could not drop a few pounds with Ozempic and when you cease taking it, you’ll possible acquire the burden proper again.
Not everybody loses weight taking these drugs, which is vital to notice, in any other case individuals who don’t drop a few pounds on these meds are left feeling like failures.
The analysis on semaglutide for weight reduction largely comes from the STEP trials, randomized managed trials (RCTs) that are funded by, you guessed it, the pharmaceutical firm that makes this drug, Novo Nordisk.
When trying solely on the STEP trials, outcomes present that 80% of individuals taking these drugs lose some quantity of weight. So about 20% of oldsters who take these meds gained’t lose any weight. For individuals who do drop a few pounds, on the very least, they’re dropping about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).
Roughly half of the parents who took this remedy noticed a extra reasonable weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of oldsters taking this remedy noticed a fairly substantial weight lack of 20% or extra physique weight (about 40 lbs weight reduction for somebody weighing 200 lbs). This extra substantial weight reduction is in fact what’s driving all of the hype and media protection on these drugs.
However let’s needless to say these trials weren’t solely funded by the maker of the drugs but in addition had a whole lot of exclusion standards. Folks couldn’t be a part of these research in the event that they had been depressed, had any present cardiovascular points, and in the event that they had been females of childbearing age with no extremely efficient contraception technique, simply to say a number of.
Whenever you take a look at different trials on semaglutide, with out the pharma funding and intensive exclusion standards, the outcomes are much less spectacular. Solely 40% of oldsters are dropping not less than 5% of physique weight. a meta-analysis (overview) of RCTs, most weight reduction totals hovered round a median of 8-10 lbs, with a number of research displaying extra vital weight reduction, round 25-40 lbs.
In case your purpose is to lose about 5-10% of your physique weight then these drugs may assist you to get there however if you’re searching for extra dramatic weight reduction, these meds in all probability gained’t assist you to meet your objectives.
It’s additionally vital to acknowledge what occurs whenever you cease taking the drugs. As a result of possibly your insurance coverage will cease overlaying it, or you’ll be able to not afford it, or there’s a scarcity, and many others.
Research have checked out what occurs whenever you take somebody off semaglutide and exchange it with a placebo and located that weight regain occurs in a short time. Inside a yr, individuals regain nearly all of their weight misplaced, even whereas nonetheless doing behavioral interventions like diet, train, and cooking courses.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a weight loss program (you acquire it again).
2. Ozempic comes with very disagreeable unwanted side effects.
Research present {that a} vary of 60% as much as 93% of individuals taking these drugs will expertise some unwanted side effects – the most typical being gastrointestinal misery. These unwanted side effects could embrace nausea, vomiting, diarrhea, constipation, GERD, and stomach ache. For most individuals, extreme GI signs ought to resolve inside a number of days and extra delicate GI unwanted side effects often resolve inside 8-12 weeks.
These drugs additionally include a black field warning that they will enhance the danger of thyroid tumors. That is primarily based purely on research finished in rodents so we don’t understand how that extrapolates to people, but. There are human research being carried out now however we gained’t know the outcomes till 2035 on the earliest. Due to this these drugs are contraindicated for these with a household historical past of thyroid tumors.
There are different very uncommon unwanted side effects like pancreatitis, gallbladder illness, kidney damage, and suicidal ideation. The FDA additionally lately added ileus to the listing of unwanted side effects on the label, which is when your bowel stops functioning and you’ll’t take away waste – it will possibly solely be handled with surgical procedure and may be deadly.
After which there’s the aesthetic reported facet impact persons are speaking about, “Ozempic face”. On account of speedy weight reduction (for some) and sure not getting ample diet, individuals report having unfastened pores and skin on their face and a hollowing beneath the eyes and close to the temples. This look can be seen in these affected by malnutrition.
3. There’s a scarcity of those weight reduction medicine, which is main compounding pharmacies to create variations that aren’t permitted or regulated.
When a drug goes on the FDA drug scarcity listing, the FDA permits compounding pharmacies to combine up their very own model of the drug with none FDA approval or screening.
However, right here’s the catch. Novo Nordisk has a has a patent on the semaglutide molecule and solely they will produce it till 2032 so compounding pharmacies don’t have entry to this energetic ingredient.
If you wish to take a weight reduction remedy, get a prescription out of your physician and safe it from a licensed pharmacy. Keep distant from wellness facilities, spas, or telehealth suppliers touting these drugs at a low value.
4. There’s no long-term knowledge on Ozempic.
Let’s not overlook that we now have NO long run knowledge on these medicine. Semaglutide was permitted by the FDA for diabetes therapy in 2017 and the longest examine I discovered was follow-up with just a little over two years. We simply don’t know if there are any long-term unwanted side effects. We additionally don’t know for those who preserve your weight reduction whenever you keep on this drug long-term.
It’s an eerily comparable image to previous weight reduction meds like Fen-Phen and Ephedra, each of which had been hailed as miracle weight reduction medicine with no long-term knowledge and had been ultimately taken off the market due to irreversible severe adversarial unwanted side effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and dying.
It’s vital to weigh this when deciding to take the remedy – you merely can’t know what the security or efficacy is of taking Ozempic long-term. What we do know is that if you wish to have a shot at sustaining your weight reduction, you’ll have to keep on it long-term.
5. Ozempic may be harmful for these with a historical past of an consuming dysfunction or disordered consuming.
This remedy in the end places you out of contact along with your physique’s pure starvation and fullness cues, which is counterproductive to consuming dysfunction restoration and the intuitive consuming framework. It causes you to eat much less, which might exacerbate and gasoline already restrictive consuming patterns, and result in potential nutrient deficiencies.
For these with binge consuming dysfunction or who wrestle with episodes of binging, coming off the remedy can lead to vital upswings in starvation, which can make you extra inclined to binges.
After which there’s the impression of weight modifications in your psychological well being. In the event you don’t drop a few pounds taking the remedy, chances are you’ll go to extremes to limit your meals consumption. Or shedding pounds could set off you to wish to lose much more, fueling extra restriction. Or for those who lose vital weight after which acquire all of it again when you come off the remedy, that change in physique look could trigger emotional misery and result in disordered consuming.
In the identical manner I wouldn’t advocate a weight loss program or intentional weight reduction to of us with an energetic consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t advocate these weight reduction drugs both. It reinforces the concept that skinny is finest and leads to insufficient nourishment and diet.
In case you are struggling to get ample diet whereas taking one in every of these drugs or are debating on taking one in every of these drugs and would love extra individualized diet help, our group would love that can assist you. Guide a diet evaluation as we speak.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://dom-pubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.14863
https://pubmed.ncbi.nlm.nih.gov/35441470/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full
Consuming Problems & Diabetes: A Give attention to Diabetes Drugs Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
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